Coronavirus Meets the Great Influenza Pandemic Robert Barro, Jose Ursua, Joanna Weng 20 March 2020

Total Page:16

File Type:pdf, Size:1020Kb

Coronavirus Meets the Great Influenza Pandemic Robert Barro, Jose Ursua, Joanna Weng 20 March 2020 Coronavirus meets the Great Influenza Pandemic Robert Barro, Jose Ursua, Joanna Weng 20 March 2020 What is a plausible worst-case scenario for outcomes under COVID-19? This column draws lessons from the 1918-1920 Great Influenza Pandemic. Data for 43 countries imply flu-related deaths back then of 39 million, 2% of the world population, implying 150 million deaths when applied to current population. Controlling for effects from WWI, GDP and consumption in the typical country declined by 6% and 8%, respectively, while real returns on stocks and short-term government bills fell meaningfully. Large potential losses in lives and economic activity justify current policy actions to limit the damage, but there is a difficult tradeoff between mortality and lost output, and this tradeoff warrants discussion that is absent so far. Beyond contagion and deaths, the spread of the new coronavirus (COVID-19) has led to stock- market crashes, surging financial volatility, decreases in nominal interest rates, and contractions of real economic activity. At this point, there is substantial uncertainty around the eventual scale of the pandemic and its economic implications, especially in terms of how a worst-case scenario could look like. We think the Great Influenza Pandemic provides a reasonable upper bound in terms of mortality and economic effects, as analyzed from the cross-country experience in Barro, et al. (2020). The pandemic arose in three main waves, the first in spring 1918, the second and most deadly from September 1918 to January 1919, and the third from February 1919 through the remainder of the year (with some countries having a fourth wave in 1920). The two initial waves coincided with the final year of World War I (1918), which helped to spread the infection across countries. An unusual feature of the pandemic was the high mortality among young adults without pre- existing medical conditions. It also killed a number of famous people, including sociologist Max Weber, artist Gustav Klimt, and Frederick Trump, the grandfather of the current US president. Survivors included economist Friedrich Hayek, entrepreneur Walt Disney, and US President Woodrow Wilson.1 In this column we discuss lessons of the Great Influenza Pandemic in three areas: (1) mortality and morbidity, (2) macroeconomic effects gauged by declines in GDP and consumption, and (3) impacts on financial returns and inflation. Mortality and morbidity Figure 1 shows our estimates of excess mortality rates from the Great Influenza Pandemic for 43 countries during 1918-1920. The data come from an array of sources, detailed in Ursúa (2009) and Weng (2016). Important references are Johnson and Mueller (2002), Murray, et al. (2006), Mitchell (2007), and the Human Mortality Database (www.mortality.org). The countries in our sample constitute 89% of estimated world population in 1918, and an even larger fraction of world GDP at the time. Flu mortality varied greatly across countries, with some countries seeing very low rates. The highest rate by far is for India, cumulating to 5.2% during the pandemic. China’s death rate was not nearly as high, but because of its large population, it contributed significantly to the number of global deaths. The US had a cumulative death rate of 0.5%, with an associated number of deaths of 550,000. Adding up the estimates by country and inflating to the world’s population (assuming comparable flu death rates in the uncovered places) yields a total number of flu deaths of 26.4 million in 1918, 9.4 million in 1919, and 3.1 million in 1920, for a world total of 39 million over 1918-1920. As shares of the population, the figures are 1.38% for 1918, 0.49% for 1919, and 0.16% for 1920; the sum of these death rates is 2.0%. Applying that death rate to the current world population (about 7.5 billion) generates staggering mortality numbers: 150 million worldwide deaths and 6.5 million US deaths. However, these numbers likely represent the worst-case scenario today, particularly because health procedures are more advanced than in 1918-20, although other factors like greater international travel work in the opposite direction. In addition, those worst-case scenarios do not account for differences in demographic profiles of the Great Influenza Pandemic and COVID-19. Figure 1 Flu death rates during the Great Influenza Pandemic (sum 1918-1920) Source: Table 1 in Barro, et al. (2020) and sources cited therein. Mortality rates are sometimes expressed as shares of numbers infected, but these are much less reliable because they depend on inaccurately measured counts of infections. For the Great Influenza Pandemic, a commonly quoted figure is that roughly one-third of the world’s population was infected by the H1N1 virus. If this number were accurate, a mortality rate of 2.0% for the overall population as we estimated would translate into a mortality rate of 6% of for the infected population. But the latter has to be regarded as highly speculative, because it is based on surveys done in a few places in the US (as described by Frost 1920). This is why in our analysis of macroeconomic effects we use mortality rates out of the total population. Macroeconomic effects for GDP and consumption Barro and Ursúa (2008) found that the macroeconomic impact of the Great Influenza Pandemic might have been substantial. That research focused on macroeconomic disasters, defined as cumulative declines by more than 10% in real per capita GDP or consumption (based on data on real personal consumer expenditure). The results suggested that the pandemic may have been the fourth most important negative macroeconomic shock for the world since 1870 – coming after WWII, the Great Depression of the early 1930s, and World War I. Specifically, 12 countries were found to have suffered macro disasters based on GDP and eight countries based on consumption, with trough years between 1919 and 1921. With an expanded dataset, we can now distinguish the effects of the pandemic from the war it partly overlapped with by exploiting variations across countries in flu death rates from 1918 to 1920 and war death rates from 1914 to 1918. Our analysis reveals statistically significant negative effects of flu and war death rates on economic growth, illustrated in Figure 2. The Great Influenza Pandemic is estimated to have reduced real per capita GDP and consumption of the typical country by 6.0% and 8.1%, respectively. WWI is associated with declines in GDP and consumption by 8.4% and 9.9%, respectively. These numbers accord with the observation we made before that the pandemic could have caused a substantial number of rare macroeconomic disasters. In addition, our econometric exercises show that at least part of the negative effect of the war on GDP was permanent, but the flu effects might have been permanent, temporary, or somewhere in between.2 Figure 2 Baseline estimates of the impact of flu and war death rates on GDP and consumption in typical country Source: Tables 1-3 in Barro, et al. (2020). Impact on financial returns and inflation To assess the impact of flu and war death rates on financial variables, we follow the same econometric strategy as for macroeconomic variables, and we focus on real returns on stocks (based on broad market indices) and short-term government bills. The nominal asset returns were adjusted for consumer price inflation to compute real returns. For the typical country, stock returns were estimated to be negatively impacted by 26 percentage points and 19 percentage points, respectively, by flu and war deaths. For bill returns, the negative effects were 14 percentage points and 13 percentage points, respectively. These outcomes were probably driven in part by strongly positive effects of the Great Influenza Pandemic and WWI on inflation rates. Implications for the COVID-19 pandemic The Great Influenza Pandemic of 1918-1920 represents a plausible worst-case scenario for disease outbreaks with global reach like COVID-19. The former’s death rate of 2% of the total population translates into 150 million deaths today. Further, that death rate corresponds to estimated declines in GDP and consumption in the typical country by 6% and 8%, respectively. In addition, the pandemic was associated with sizable declines in real rates of return on stocks and short-term bills. At this point, the probability that COVID-19 reaches anything close to the Great Influenza Pandemic seems remote, given epidemiological differences, advances in public health, and mitigating policies at play. In any event, the large potential losses in lives and economic activity justify substantial expenditure of resources to attempt to limit the damage. In effect, countries have been pursuing policies of lowering real GDP as ways to curb the spread of the disease. There is clearly a difficult trade-off here concerning lives versus material goods, with little ongoing discussion about how this tradeoff should be assessed and acted upon References Barro, R J and J F Ursúa (2008), "Macroeconomic Crises since 1870", Brookings Papers on Economic Activity 39: 255-350. Barro, R J, J F Ursúa and J Weng (2020), "The Coronavirus and the Great Influenza Pandemic. Lessons from the “Spanish Flu” for the Coronavirus’s Potential Effects on Mortality and Economic Activity", NBER working paper 26866. Frost, W H (1920), “Statistics of Influenza Morbidity: with Special Reference to Certain Factors in Case Incidence and Case Fatality”, Public Health Reports 35(11): 584-597. Johnson, N P A S and J Mueller (2002), “Updating the Accounts: Global Mortality of the 1918- 1920 ‘Spanish’ Influenza Pandemic”, Bulletin of the History of Medicine 76(1): 105 115. Mitchell, B R (2007), International Historical Statistics, Palgrave. Murray, C, A D Lopez, B Chin, D Feehan, and K H Hill (2006), “Estimation of Potential Global Pandemic Influenza Mortality on the Basis of Vital Registry Data from the 1918–20 Pandemic: A Quantitative Analysis”, The Lancet 368(9554): 2211–2218.
Recommended publications
  • WIDER Working Paper 2020/124-The Great Influenza Pandemic of 1918
    WIDER Working Paper 2020/124 The Great Influenza Pandemic of 1918–20 An interpretative survey in the time of COVID-19 Prema-chandra Athukorala1 and Chaturica Athukorala2 October 2020 Abstract: The Great Influenza Pandemic of 1918-20—commonly known as the Spanish flu— infected over a quarter of the world’s population and killed over 50 million people. It is by far the greatest humanitarian disaster caused by infectious disease in modern history. Epidemiologists and health scientists often draw on this experience to set the plausible upper bound (the ‘worst case scenario’) on future pandemic mortality. The purpose of this study is to piece together and analyse the scattered multi-disciplinary literature on the pandemic in order to place debates on the evolving course of the current COVID-19 crisis in historical perspective. The analysis focuses on the changing characteristics of pathogens and disease over time, the institutional factors that shaped the global spread, and the demographic and socio-economic consequences. Key words: Spanish flu, COVID-19, pandemic, infectious JEL classification: F50, I10, O50, Z19 Acknowledgements: The authors are grateful to Sisira Jayasuriya for stimulating their interest in this subject and to Wishnu Mahraddhika and Wannaphong Durogkaveroj for assistance with accessing Indonesian- and Thai-language literature, respectively. They thank Soma Athukorala for help with the literature search and gratefully acknowledge comments received from Tony Addison, Hal Hill, and the participants of the Trade and Development Seminar in the Arndt-Corden Department of Economics, Australian National University. 1 Arndt-Corden Department of Economics, Crawford School of Public Policy, Australian National University, Canberra, Australia; corresponding author: [email protected]; 2 Department of Medical Imaging, The Canberra Hospital, Australia, [email protected] This study has been prepared within the UNU-WIDER project on Academic excellence.
    [Show full text]
  • The Great Influenza Also by John M
    THE GREAT INFLUENZA ALSO BY JOHN M. BARRY Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America Power Plays: Politics, Football, and Other Blood Sports The Transformed Cell: Unlocking the Mysteries of Cancer (with Steven Rosenberg) The Ambition and the Power: A True Story of Washington THE GREAT INFLUENZA The Epic Story of the Deadliest Plague in History JOHN M. BARRY VIKING VIKING Published by the Penguin Group Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, U.S.A. Penguin Books Ltd, 80 Strand, London WC2R 0RL, England Penguin Books Australia Ltd, 250 Camberwell Road, Camberwell, Victoria 3124, Australia Penguin Books Canada Ltd, 10 Alcorn Avenue, Toronto, Ontario, Canada M4V 3B2 Penguin Books India (P) Ltd, 11 Community Centre, Panchsheel Park, New Delhi – 110 017, India Penguin Books (N.Z.) Ltd, Cnr Rosedale and Airborne Roads, Albany, Auckland, New Zealand Penguin Books (South Africa) (Pty) Ltd, 24 Sturdee Avenue, Rosebank, Johannesburg 2196, South Africa Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England Copyright © John M. Barry, 2004 All rights reserved Photograph credits appear on Back Matter. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Barry, John M. The great influenza: the epic story of the deadliest plague in history / John M. Barry. p. cm. Includes bibliographical references. ISBN: 1-101-20097-9 1. Influenza—History—20th century. I. Title. RC150.4.B37 2004 614.5'18'09041—dc22 2003057646 Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.
    [Show full text]
  • How the Horrific 1918 Flu Spread Across America
    How the Horrific 1918 Flu Spread Across America The toll of history’s worst epidemic surpasses all the military deaths in World War I and World War II combined. And it may have begun in the United States An emergency hospital at Camp Funston, Kansas, 1918. “Of the 12 men who slept in my squad room, 7 were ill at one time,” a soldier recalled. (New Contributed Photographs Collection / otis historical Archives / National Museum of Health and Medicine) By John M. Barry Smithsonian Magazine November 2017 Haskell County, Kansas, lies in the southwest corner of the state, near Oklahoma and Colorado. In 1918 sod houses were still common, barely distinguishable from the treeless, dry prairie they were dug out of. It had been cattle country—a now bankrupt ranch once handled 30,000 head—but Haskell farmers also raised hogs, which is one possible clue to the origin of the crisis that would terrorize the world that year. Another clue is that the county sits on a major migratory flyway for 17 bird species, including sand hill cranes and mallards. Scientists today understand that bird influenza viruses, like human influenza viruses, can also infect hogs, and when a bird virus and a human virus infect the same pig cell, their different genes can be shuffled and exchanged like playing cards, resulting in a new, perhaps especially lethal, virus. We cannot say for certain that that happened in 1918 in Haskell County, but we do know that an influenza outbreak struck in January, an outbreak so severe that, although influenza was not then a “reportable” disease, a local physician named Loring Miner—a large and imposing man, gruff, a player in local politics, who became a doctor before the acceptance of the germ theory of disease but whose intellectual curiosity had kept him abreast of scientific developments—went to the trouble of alerting the U.S.
    [Show full text]
  • The Coronavirus and the Great Influenza Pandemic: Lessons from the “Spanish Flu” for the Coronavirus’S Potential Effects on Mortality and Economic Activity
    NBER WORKING PAPER SERIES THE CORONAVIRUS AND THE GREAT INFLUENZA PANDEMIC: LESSONS FROM THE “SPANISH FLU” FOR THE CORONAVIRUS’S POTENTIAL EFFECTS ON MORTALITY AND ECONOMIC ACTIVITY Robert J. Barro José F. Ursúa Joanna Weng Working Paper 26866 http://www.nber.org/papers/w26866 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 March 2020, Revised April 2020 The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications. © 2020 by Robert J. Barro, José F. Ursúa, and Joanna Weng. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. The Coronavirus and the Great Influenza Pandemic: Lessons from the “Spanish Flu” for the Coronavirus’s Potential Effects on Mortality and Economic Activity Robert J. Barro, José F. Ursúa, and Joanna Weng NBER Working Paper No. 26866 March 2020, Revised April 2020 JEL No. E1,I0,O4 ABSTRACT Mortality and economic contraction during the 1918-1920 Great Influenza Pandemic provide plausible upper bounds for outcomes under the coronavirus (COVID-19). Data for 48 countries imply flu-related deaths in 1918-1920 of 40 million, 2.1 percent of world population, implying 150 million deaths when applied to current population. Regressions with annual information on flu deaths 1918-1920 and war deaths during WWI imply flu-generated economic declines for GDP and consumption in the typical country of 6 and 8 percent, respectively.
    [Show full text]
  • Book Reviews
    BOOK REVIEWS JOHN M. BARRY The Great Influenza: The Epic Story of the Deadliest Plague in History New York: Viking Press, 2004. 546 p. $29.95. The 1918–19 influenza pandemic killed more than 40 million people worldwide, making it one of the most significant demographic events of the last 200 years (Johnson and Mueller 2002). A notable comparison is that there were on the or- der of 34 million combat deaths in all the wars of the twentieth century combined (Brzezinski 1993: 9). But the 1918–19 pandemic was more than just a magnified version of the typical year-in/year-out flu season: it killed in a tri-modal W-shaped age-mortality profile, instead of the typical U-shaped profile of the very young and very old. In relation to its magnitude and other interesting traits, study of the 1918 epidemic has been neglected by demographers, though happily this is begin- ning to change. Among historians, interest in the 1918–19 pandemic reawakened in the 1970s. Richard Collier’s 1974 book, The Plague of the Spanish Lady, was reissued in paper- back in 1996 and remains in print. It is more anecdotal than analytical, being based mostly on hundreds of interviews with survivors, but nonetheless is a useful ac- count of how the epidemic was experienced. Collier’s title alludes to the “Spanish Flu,” as the pandemic used to be called, because Spain, not a party to World War I, did not censor newspapers whereas the belligerent European countries suppressed bad news in the name of patriotism.
    [Show full text]
  • A Day (Nearly) Like Any Other: Healthcare Work in an Influenza Pandemic
    A DAY (NEARLY) LIKE ANY OTHER: HEALTHCARE WORK IN AN INFLUENZA PANDEMIC CAROLINE SAINT A THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY FACULTY OF LAW UNIVERSITY OF SYDNEY JANUARY 2017 I ABSTRACT The World Health Organization has long anticipated an outbreak of a highly pathogenic influenza. Fear of a highly virulent influenza has been compounded by the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) where some health workers refused to work. In light of this, the question has been asked whether healthcare workers would continue to work during an influenza pandemic. Worryingly, surveys suggest that many would not. The thesis explores past experience of some ‘new’ infectious diseases and how these impacted on the health workforce. It considers evidence from the 1918 influenza pandemic, where (for the most part) nurses were not over-represented in the death statistics. It is argued that all infectious disease is not the same and a one-size approach by way of either compulsion or incentives to work should not be adopted. In situations where a healthcare worker faces a higher risk of infection and serious illness than the general population and attending at work could expose their family to additional risk (as was the case in SARS) consideration may need to be given to incentives to encourage work performance rather than any form of compulsion. However, the thesis argues that the health workforce would not be at greater risk during an influenza pandemic and the common law contract of employment sufficiently compels work performance, with public sector employees having a greater obligation to work than might their private sector counterparts.
    [Show full text]
  • The Great Influenza Epidemic of 1918 and Its Legacy for Arkansas
    7 Epidemic! The Great Influenza Epidemic of 1918 and Its Legacy for Arkansas THOMAS A. DEBLACK In late January and early February 1918, a doctor in remote Haskell County, Kansas, began to see patients complaining of fever, body aches, headaches, and coughing. He had seen the symptoms before, and he correctly diagnosed the patients with influenza. But there was something different about this flu. It was “violent, rapid in its progress through the body, and sometimes lethal.” Unlike most flus, this one did not con- form to the traditional “U” curve, infecting the oldest and youngest most severely. Instead, it followed a “W” curve, attacking not only the extremes but those in the middle—healthy people of young and middle age.1 Soon the doctor was overwhelmed, and some of his patients began to die. Alarmed, he began to send reports to national public health officials about the outbreak. Schools in the county closed. Then in March, the disease disappeared as quickly as it had emerged. The schools reopened, and life returned to normal. The doctor remained concerned, but few outside the county paid any attention. Influenza was not then considered a “reportable” disease (one that the law required physicians to report).2 But in fact, what the Kansas doctor had diagnosed was the first strand of what would become a worldwide pandemic dubbed the “Spanish flu.” The flu was not Spanish at all. In May 1918, the Spanish king, the prime | DOI: https://doi.org/10.34053/christ2019.twah.7 147 minister, and the prime minister’s entire cabinet all came down with the disease, and the country’s newspapers—not hindered by the censor- ship that hampered the press in the warring nations of Europe—freely reported on it.3 Thus the name “Spanish flu” was born.
    [Show full text]